Mgr- Fep Claims

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

PURPOSE OF THE JOB

The Claims Manager upholds and administers claims processing, oversees the daily operations of the Claims Department, and ensures adherence to corporate policy and procedure and contractual and regulatory guidelines for claims administration.
- Oversight of day-to-day activities of Claims processing, including, provider claim issues, system issues and auto-adjudication.
- The Manager of Claims Operations is accountable for instilling and supporting a culture of customer-centricity within the area.
- Responsible for the professional development and coaching of all reporting staff and setting effective goals to drive performance.
- Responsible for planning, organizing, developing, and directing tactics to execute segment specific and corporate strategies.
- Accountable for effectively overseeing all activities that ensure the execution of internal processes, championing, and leading efforts to enhance processing, as well as empowering and enabling employees to implement operational efficiencies.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

1. Required Work Experience
- 3 years of experience in supervisory/management field as a people leader
- 3 years in healthcare or related field

2. Required Education
- High-School Diploma or GED in general field of study

3. Required Licenses
- N/A

4. Required Certifications
- N/A

PREFERRED QUALIFICATIONS

1. Preferred Work Experience
- 5 years claims processing or related claims experience.
- 5 years of experience in supervisory/management field as a people leader

2. Preferred Education
- Bachelor’s Degree Preferred

3. Preferred Licenses
- N/A

4. Preferred Certifications
- N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
- Oversee daily claims activities to ensure regulatory claims compliance.
- Manage inventory to meet department metrics.
- Initiate strategic planning for continuous improvement.
- Responsible to look for opportunities for automation, including, but may not be limited to claims system auto adjudication and robotic processing automation (RPA).
- In conjunction with Training & Development, ensure appropriate training materials, workflows and training sessions are available for all Claims staff.
- Ensures policies and procedures relevant and updated.
- Continually reviews and makes necessary adjustments for claims processor production and quality standards.
- Resolve staff issues related to claims operations, inclusive of HR issues and resolution.
- Develop and maintain working relationship with other Departmental Managers
- Works with IS staff to ensure appropriate system modifications and setup, inclusive of updated regulatory fee schedules.
- Responsible for regulatory reporting, audits, and operational reviews
- Support team leads and provide guidance and oversight of department resource allocation to support corporate and departmental goals and objectives. This includes accountability for ensuring system defect ticket resolution, as well as accountability for coordinating with team leads and resource planning support to execute strategies for effectively managing inventories.
- Support reporting staff and our members with accepting and owning resolution of management escalations.
- Represent the department/division in external meetings. Participates on an internal basis in meetings and decision-making processes as it relates to the specific area of responsibility. Demonstrate a high degree of executive presence.
- Must have the ability to make appropriate decisions based on information at hand with the ability to focus on the big picture while looking for opportunities for improvement.
- Provide motivation and encouragement to subordinates, conduct performance evaluations, identify and coordinate training needs, make determinations regarding disciplinary actions.
- Provides motivation and encouragement to subordinates during monthly coaching as well as a structured path for technical and professional growth and advancement opportunities.
- Perform activities related to interviewing, hiring, termination, disciplinary action, performance progression, and salary administration as required.
- Ability to think outside the box and objectively and professionally challenges the status quo that engages others in constructive dialogue to achieve results. Builds and fosters good working relationships with internal customers and peers.
- Ensure that staff performs essential job functions to maximize corporate performance scores related to the area’s responsibilities (i.e.IPP, MTM and related performance guarantees).
- The position requires a full-time work schedule. Full-t